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Group Tuberculosis Written Report

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Manuel V. Gallego Foundation Colleges, Inc.

Institute of Nursing and Allied Health Colleges

Cabanatuan City, Nueva Ecija

Official Written Report of Group Tuberculosis

The Pathophysiology of Mycobacterium Tuberculosis

Submitted by:

Leah Dela Cruz

Venus Isla

Ericka Paraiso

Hyline Quijano

Submitted to:

Prof. Zeshalyn Fajardo


Tuberculosis

(a) Introduction

Tuberculosis is an infectious disease caused by bacteria that predominantly affects the


lungs but may affect other parts of the body. The strain Mycobacterium tuberculosis
causes tuberculosis—an absolutely preventable and curable disease yet still a
significant global public health concern. The prevalence and impact of TB on global
health were underlined by the WHO, which estimated that there were 10 million people
suffering from active TB and 1.5 million deaths from TB alone in 2020.
It is relevant to nursing simply because TB has an extremely high prevalence,
particularly in low- and middle-income countries. Because nurses are the ones
responsible for identifying, treating, and managing TB, their knowledge of its general
pathogenesis, transmission, and control measures becomes very important. This is
underscored by the fact that multi-drug resistance to TB was recently developed, which
has become a challenge for healthcare providers, underscoring the essence of
extending comprehensive knowledge on this infectious disease and updating practices
toward the management of TB.

(b) Etiology and Pathogenesis


Tb is caused by mycobacterium tuberculosis, a slow-growing, rod-shaped bacteria with
a peculiar cell wall rich in lipids, accountable for its feature of resistance against
desiccation and disinfectants, is what causes tuberculosis. The primary entry route for
this bacterium is airborne droplets when an infected person coughs, sneezes, or
speaks. *M. inhaled thereafter. Upon entering the alveoli, the bacilli are phagocytosed
by alveolar macrophages. By preventing the fusion of phagosomes and lysosomes,
these bacteria evade the host's immune system and multiply within the macrophages. A
cell-mediated host immune response results in the formation of granulomas, a self-
contained response to this infection. While in some, the bacteria may remain dormant,
in others, latent TB infection may progress to active TB disease, especially in those who
are immunocompromised.

(c) Microbial Characteristics


Morphology: Mycobacterium tuberculosis, the causative agent of TB, is characterized
by its morphology. It is a long, slender, rod-shaped bacterium measuring about 2-4
micrometers in length and 0.2–0.5 micrometers in thickness. What sets M. What sets
tuberculosis apart from other bacteria is the composition of its cell wall. Due to the high
amount of lipids, especially mycolic acids, its cell wall is highly impermeable to the
environment, thus making the bacterium pretty resistant to stresses.
Genetics: By genetic consideration, Mycobacterium tuberculosis is an extremely
complex organism that has one circular chromosome. The genome size is
approximately 4.4 million base pairs, which encode around 4,000 genes. It is through its
genetic material that the bacterium causes pathogenesis by not only evading host
immune responses but also by persisting in macrophages and surviving latently for such
a long period through evasion of host immune mechanisms. Variation in the genotype of
M. Tuberculosis strains may modify the virulence and drug susceptibility patterns of the
bacterium, consequently altering transmission dynamics.
Metabolic Characteristics: Mycobacterium tuberculosis is considered a slow-growing
bacterium and needs certain specialized metabolic adaptations to survive. It is an
obligate aerobe that thrives in the presence of oxygen. Unique cell wall lipids are
exploited, as are complex metabolic pathways that aid survival in the host. M. It has a
relatively low metabolic rate compared to other bacteria, which might explain the
intrinsic resistance to antibiotics and the establishment of chronic infections in host
tissues.

(d) Modes of Transmission


Tuberculosis is majorly spread through the respiratory route from droplets containing
the mycobacterium. Transmission occurs when an infected person excretes respiratory
droplets into the environment through coughing or sneezing, talking, singing, or any
other action that dispensers respiratory secretions into the air. They settle into the
environment afterwards and can remain there for a longer period of time to become very
dangerous on inhalation.
There are two major modes of TB transmission:
Airborne Transmission: By far the most common mode of transmission of the TB
bacillus is by inhaling airborne particles infected with M. tuberculosis. When a patient
with active pulmonary TB coughs or sneezes, small droplets containing the bacteria
come out into the atmosphere. The droplet can be inhaled into the body of a nearby
person, by which the organism can then develop into the lungs and replicate to form an
infection. Circumstances that increase a person's chance of acquiring an illness via
airborne transmission are poor ventilation factors, overcrowding, or staying in the
presence of an infectious person for too long.
Droplet Transmission: More significant respiratory droplets, projectiles expectorated
by talking, singing, or laughing by the infected host, can also transmit TB. These are of
larger and heavier composition compared to those involved in airborne transmission but
still have the ability to harbour M. tuberculosis, infecting anybody who is in close contact
with the droplet producer. Droplet transmission usually occurs over shorter distances.
Specific infection prevention and control measures can thus be applied in health care
settings to halt the progression of this disease.
Because TB is an airborne transmission, certain physical environments and populations
are more at risk of exposure. Environments most likely to bring people into close
proximity—healthcare facilities, congregate settings, correctional facilities, and
homeless shelters—have an increased risk of person-to-person transmission. Individual
circumstances resulting in impaired immunity, namely those living with HIV/AIDS or
malnutrition, increase the risk of developing active cases of TB if they have become
infected with the bacterium.
Control of transmission of TB includes early detection and effective treatment of active
cases, infection control measures within health care facilities, ventilation and respiratory
hygiene practices, contact investigations leading to identification and screening of
people exposed, and awareness regarding transmission and prevention of TB within
communities. In the event that a healthcare provider or public health authority can
identify the major transmission modes of this infectious disease, they would be able to
plan effectively for interventions that deal with ways of mitigating its impacts in reducing
the burden of this airborne infectious disease worldwide.

(e) Clinical manifestations and symptoms


Early detection and treatment of tuberculosis (TB) hinges on spotting its clinical signs.
This matters a lot to stop it from getting worse or spreading. TB shows up in different
ways. It mostly hits the lungs but can attack other body parts too. People with TB often
cough for more than three weeks straight. They might spit up stuff, sometimes with
blood in it. Breathing or coughing can hurt their chest. They might run a fever, sweat at
night, and lose weight fast. Feeling tired all the time and not wanting to eat are common
too. TB can break out of the lungs and cause trouble elsewhere. This leads to all sorts
of weird symptoms. Lymph nodes might swell up. The lining around the lungs could get
inflamed. Brain membranes could get infected. It can even mess with bones, joints,
kidneys, or guts. Doctors need to know all these different ways TB can pop up. This
knowledge helps them nail down what’s wrong and treat it right away.

(f) Diagnostic methods


Accurate and timely diagnosis of tuberculosis (TB) is important for treating and
managing the disease effectively. It’s also crucial for identifying TB strains that are
resistant to drugs and need specific treatment plans. To diagnose TB, doctors use a
combination of methods like clinical evaluation, lab tests, and imaging techniques. The
clinical evaluation starts with a thorough medical history and physical examination to
spot symptoms like a persistent cough, chest pain, unexplained weight loss, fever, and
night sweats.
Lab tests include something called sputum smear microscopy, where they stain a
sputum sample and check it under a microscope to find those pesky tuberculosis
bacteria. Nucleic acid amplification tests (NAATs) are super handy when it comes to
detecting genetic material from the tuberculosis bacillus. They give us quicker and more
accurate results, which is especially helpful when dealing with drug-resistant strains.
To spot any lung abnormalities that might suggest tuberculosis, we often turn to imaging
tests like chest x-rays. But if we want a more detailed picture, computed tomography
(CT) scans are where it’s at. They can identify damage caused by tuberculosis that
might not show up on standard x-rays. Now, when it comes to choosing which
diagnostic method to use, it all depends on the patient’s symptoms, risk factors, and
what resources are available. That’s why we need a comprehensive approach to make
sure we diagnose and treat tuberculosis effectively.

(g) Treatment and Management


Treating and managing tuberculosis (TB) is super important to cure the disease, stop it
from spreading, and lower the risk of drug-resistant TB. Getting the right treatment
quickly not only helps with symptoms and improves patient outcomes, but also reduces
the chances of passing it on to others.
The usual treatment for TB involves taking a combination of antibiotics for a long time,
usually around six months or more. The most common medicines used are isoniazid,
rifampicin, ethambutol, and pyrazinamide. Treating drug-resistant TB can be more
complicated and take longer, often needing stronger medications with more side effects.
Nurses play a big role in managing TB by making sure patients follow their treatment
plan, keeping an eye out for side effects, and educating them about the importance of
finishing the whole course of therapy. Nurses also provide support for dealing with
symptoms and maintaining overall health, including giving advice on nutrition and
infection control. To effectively control and eventually get rid of TB, it’s crucial to have
comprehensive treatment and management strategies in place.

(h) Prevention and Control


Preventing and controlling tuberculosis TB is important in reducing the spread of this
infectious disease. By implementing effective measures, we can significantly decrease
the transmission of TB, protecting both individuals and communities. One key measure
is getting vaccinated with the Bacillus Calmette-Guérin (BCG) vaccine, especially in
countries where TB is widespread. Another crucial step is early detection and treatment
of active TB cases to reduce how contagious it is. To tackle TB, we also need to focus
on public health strategies like regular screening in high-risk populations, improving
living conditions, and promoting good respiratory hygiene.
In healthcare settings, it’s important to follow infection control practices such as using
personal protective equipment(PPE), ensuring proper ventilation, and isolating
infectious patients. Educating the public about TB transmission, symptoms, and the
importance of seeking medical care promptly is key. By combining all these measures,
we can take a comprehensive approach to prevent and control TB, with the ultimate
goal of eradicating the disease.

( I ) Case Analysis
Case: A 45-year old male patient complained of persistent cough accompanied by night
sweats, Weight loss and fatigue for the past two months. His past medical history did
not show any past TB disease or illness history, but he returned from a TB endemic
area.
Accordingly, the following clinical examination of the patient and a positive sputum
smear microscopy result, the diagnosis was further affirmed using a nucleic acid
amplification test (NAAT) and all the tests for drug susceptibility showed that the strain
belonged to Mycobacterium tuberculosis.
The patient was begun on the first line standard 6 months treatment comprising of
isoniazid, rifampicin, ethambutol, and pyrazinamide. Further nursing follow-ups aimed at
assessing the patient’s compliance with the medication as well as the emergence of
side effects during the treatment process and patient counselling on the necessity of the
proper regimen’s completion.
After the respective treatment period, the patient’s symptoms had subsided, and sputum
that was collected after the treatment was culture-negative for TB bacteria suggesting
that the patient had been cured. In a true sense, this case underlines the need for
proper diagnosis of the disease, prompt intervention, as well as a comprehensive
management to ensure aesthetic results in the patients diagnosed of TB.

(j) Conclusion
This study shows how important it is to find and treat tuberculosis (TB) correctly early
on, and to manage it well. The main points are that quick action, following the treatment
plan, and keeping an eye on the patient are all important for good results. For nurses,
this means they need to teach patients well, help them stick to their treatment, and
watch for any problems from the medicine. Nurses are very important in taking care of
TB patients by giving them full care, helping with emotional and social issues, making
sure they don’t spread the disease, and supporting efforts to stop TB. This shows that
treating TB needs many different approaches and that nurses are key to helping
patients get better and improving public health.
References
World Health Organization. (2020). Global Tuberculosis Report. Retrieved from
https://www.who.int/publications/i/item/9789240013131
Tuberculosis (TB). (2024, May 16). Retrieved from https://www.cdc.gov/tb/index.html
Zumla, A., Nahid, P., & Cole, S. T. (2013). Advances in the diagnosis and treatment of
tuberculosis. Nature Reviews Disease Primers, 2, 16076. Retrieved from
https://www.nature.com/articles/ja2017126
Pai, M., Behr, M. A., Dowdy, D., Dheda, K., Divangahi, M., Boehme, C. C., … &
Raviglione, M. (2016). Tuberculosis. Nature Reviews Disease Primers, 2, 16076.
Retrieved from https://doi.org/10.1038/nrdp.2016.76

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